Symbicort in Patients with Pneumonia
Symbicort (budesonide/formoterol) is not recommended for patients with pneumonia and may increase pneumonia risk in COPD patients, so it should be avoided during active pneumonia infections. 1, 2
Risk of Pneumonia with Symbicort
- Budesonide/formoterol (Symbicort) has been associated with an increased incidence of pneumonia adverse events in COPD patients compared to formoterol alone (6.4% for budesonide/formoterol 320/9 μg, 4.7% for budesonide/formoterol 160/9 μg, versus 2.7% for formoterol alone) 2
- While a meta-analysis of individual patient data showed that budesonide treatment for 12 months did not significantly increase pneumonia risk compared to control treatments, there remains concern about inhaled corticosteroid use during active pneumonia 1
Management of Pneumonia
- For community-acquired pneumonia (CAP), guidelines recommend specific antibiotic regimens based on severity and risk factors, not inhaled corticosteroid/long-acting beta-agonist combinations like Symbicort 3
- For outpatients with CAP, recommended treatments include amoxicillin, doxycycline, or macrolides depending on local resistance patterns 4
- For hospitalized non-ICU patients with CAP, a β-lactam plus either a macrolide or a respiratory fluoroquinolone is recommended 3, 4
- For severe CAP requiring ICU admission, combination therapy with a β-lactam plus either a macrolide or a respiratory fluoroquinolone is strongly recommended 3
Special Considerations
If a patient with pneumonia also has underlying COPD and is on Symbicort maintenance therapy, clinicians should:
- Prioritize appropriate antibiotic therapy for pneumonia based on severity and risk factors 3
- Consider temporarily discontinuing Symbicort during the acute pneumonia phase due to the potential increased risk of pneumonia 2
- Resume Symbicort after resolution of pneumonia if indicated for COPD management 5
For patients with COVID-19-related pneumonia:
- Empirical coverage for bacterial pathogens is recommended in patients with CAP without confirmed COVID-19 3
- The relevant bacterial pathogens in patients with pneumonia and COVID-19 are likely the same as in other patients with pneumonia 3
- Procalcitonin may help guide antibiotic use in confirmed COVID-19 pneumonia 3
Timing of Treatment
- All admitted patients with pneumonia should receive their first dose of antibiotic therapy within 8 hours of arrival to the hospital 3
- Most patients with CAP will have an adequate clinical response within 3 days, at which point switch to oral therapy should be considered if appropriate criteria are met 3
Conclusion
Symbicort has no therapeutic role in the treatment of pneumonia and may potentially increase pneumonia risk, particularly in COPD patients. Focus should be on appropriate antibiotic therapy based on pneumonia severity and risk factors for specific pathogens.